Wake up with numbness or burning pain in fingers after sleep

Introduction One of the symptoms of carpal tunnel syndrome is numbness or burning pain after asleep. It is because the median nerve is compressed, and the thumb, food, and middle finger produce pain and numbness. In the early stage, it often manifests as sensory dysfunction at the fingertips. It often wakes up due to numbness or burning pain several hours after falling asleep, and relieves after the activity.

Cause

(1) Causes of the disease

The carpal tunnel is a bone in the palm of the hand - the fibrous tube, the flexor hallucis longus and the four flexor digitorum tendons, the four flexor digitorum tendons and the median nerve enter the hand through this tube. The carpal tunnel is on the side of the palm of the wrist and consists of the carpal bone and the transverse ligament of the wrist. The transverse ligament of the wrist is tough and the proximal margin is thickened, which is the main factor for compressing the median nerve. The median nerve is superficially located in the carpal tunnel and is easily compressed by the transverse ligament of the wrist, causing damage.

The onset of carpal tunnel syndrome is associated with chronic injury. Hand and wrist are prone to disease when the labor intensity is high.

There are many reasons for carpal tunnel syndrome, which can be roughly divided into three categories:

Local factor

(1) Factors that cause the reduction of carpal tunnel volume: such as Colles fracture, Smith fracture, scaphoid fracture and deformity after lumbar dislocation, and acromegaly.

(2) Factors that cause an increase in the contents of the carpal tunnel: such as lipoma, fibroids, ganglion cyst, abnormal muscle position in the carpal tunnel (refer to hypotonic muscle abdomen, sacral muscle abdomen too high), non-specific synovium Inflammation, hematoma.

2. Systemic factors

(1) Factors that cause neurodegeneration: such as diabetes, alcoholism, infection, gout, etc.

(2) Factors that change body fluid balance: such as pregnancy, oral contraceptives, long-term hemodialysis, and hypothyroidism.

3. Postural factors use excessive wrist workers, such as computer operators, disabled people walking with crutches, repeated flexion and extension of fingers and wrist joints. A study of 77 paraplegic patients by Gellman et al found that 38 of them (49%) had carpal tunnel syndrome.

However, it should be noted that the cause of some patients with carpal tunnel syndrome is unclear.

(two) pathogenesis

The carpal tunnel is a fibrous fibrous tube composed of a carpal tunnel and a transverse ligament of the wrist. The temporal side of the carpal tunnel is the scaphoid and the large angle bone; the ulnar side is the pea bone and the hook bone; the back side is the skull, the scaphoid, the lunate bone and the small polygonal bone; the volar side is the transverse ligament of the wrist. The ulnar side of the transverse ligament of the wrist is attached to the pea bone and the hook bone groove, and the temporal side is attached to the scaphoid nodule and the most common bone top. The transverse ligament of the wrist is very tough, almost trapezoidal, the size of the small stamp (about 2cm × 2cm), the thickness of 1 ~ 2mm, the distal end and the palmar aponeurosis continue, the proximal end and the volar ligament (forearm deep fascia) phase Continuation, its position is about the level of the base of the wrist and metacarpal.

The carotid tube has a slightly elliptical cross section with its apex on the temporal side. In the carpal tunnel, there are 9 flexor tendons and 1 nerve (ie, the median nerve), and the ratio of the area of the carpal tunnel to the sum of the area of 9 flexor tendons and 1 nerve is about 3:1. Therefore, the area of the carpal tunnel Provides a certain amount of space for the activities of the carpal tunnel contents. The 9 tendons are divided into two layers: shallow and deep. The shallow layer refers to the superficial flexor tendon, which is arranged in order from the little finger to the index finger. The deep layer refers to the deep flexor tendon, which is arranged from the lateral side to the ulnar side. They are surrounded by two sputum synovial sheaths, namely the radial sac and the ulnar sac, and the flexor hallucis tendon is located on the shallow temporal side, and its position is relatively constant.

The median nerve is located in the superficial plane of the superficial flexor tendon (mostly located in the middle finger, the superficial flexor tendon of the ring finger), and the position is relatively constant. The median nerve is always in direct contact with the transverse ligament of the wrist. This particular local anatomical relationship is combined with the wrist. The transverse ligament is a relatively tough fibrous tissue with few elastic fibers. Therefore, the transversal deformation of the transverse ligament caused by any cause will cause friction and compression of the median nerve, especially when the wrist is stretched. The majority of the median nerve (about 95%) is divided into the inner and outer branches at the distal edge of the transverse ligament of the wrist. The lateral branch is a branch of the short abductor, the thumb and the flexor of the thumb (shallow head). The distal branch is the first finger volar total nerve, and its end is further divided into three palpital intrinsic nerves, which are distributed on the skin of the thumb, ulnar and index finger, and the intrinsic nerve to the lateral edge of the index finger. Branch to the first sacral muscle; the medial branch is divided into the 2nd and 3rd volar general nerves, and the proximal part of the metacarpophalangeal joint is divided into 2 palpital intrinsic nerves, distributed in the index finger, middle finger and middle finger, ring finger On the opposite edge of the skin, the second finger palm side total nerve also branches to the second sacral muscle. Therefore, the corresponding sensory dyskinesia occurs after the median nerve is compressed.

an examination

Related inspection

Flexion wrist test electromyogram

First, clinical manifestations

The clinical manifestations of carpal tunnel syndrome are mainly the median nerve compression index finger, middle finger and ring finger numbness, tingling or burning pain, nighttime labor, nighttime aggravation, and even wakefulness during sleep; local pain often radiates to the elbow and shoulder Department; the thumb abductor muscle strength is poor, occasionally the end object, the sudden loss of the hand when lifting.

Examination: Pain or slamming the transverse ligament of the wrist and aggravating the pain when the wrist is extended; if the course is long, there may be atrophy of the great fish muscle. Wrist, palm, thumb, index finger, middle finger appear numbness, pain, or accompanied by inflexible, incompetent hand movements; pain symptoms at night or early morning, can be radiated to the elbows, shoulders, daytime activities and post-hand loss; The feeling of the part is weakened or disappeared; even the muscles of the hand are atrophied and paralyzed. If this happens, and it will not be relieved for several days, experts suggest that you must go to a regular hospital to see a doctor as soon as possible so that you can make an early diagnosis and take measures.

Clinically, some patients may have atrophy of the "big fish" muscle under the thumb due to long-term disease; even intermittent skin whitish and cyanosis may occur; in severe cases, the thumb, index finger cyanosis, fingertip necrosis or atrophic ulcer may occur. Become an irreversible change.

Carpal tunnel syndrome occurs in the 30 to 50 age group, and women are 5 times more likely to be men. The bilateral incidence of about 1/3 to 1/2, bilateral incidence of female: male 9:1. Due to the compression of the median nerve, the thumb, food, and middle finger produce pain and numbness. In the early stage, it often manifests as sensory dysfunction at the fingertips. It often wakes up due to numbness or burning pain several hours after falling asleep, and relieves after the activity. A small number of patients have neurotrophic disorders due to long course of disease, large muscle muscle atrophy, intermittent skin whitening, cyanosis, severe cases of thumb, index finger cyanosis, fingertip necrosis or atrophic ulcer. During the examination, the center of the wrist can be slammed, causing numbness and pain in the median nerve innervation area. This is the Tinel sign. In some patients, the wrists were extremely flexed for 60 seconds, and the fingers felt abnormally aggravated. This was positive for the Phalen test. The use of a sphygmomanometer to pressurize the upper arm to the distal extremity of the vein can induce symptoms.

Second, diagnosis

If carpal tunnel syndrome is suspected, the following tests should be performed to confirm the diagnosis:

1Tinel sign. At the proximal edge of the wrist ligament, the median nerve was slammed with a finger, and the thumb, food, and middle finger were positive for radiation pain.

2 flexion wrist test. The elbows rest on the table, the forearms are perpendicular to the table, and the two wrists are naturally palmar. At this time, the median nerve was pressed to the proximal edge of the transverse carpal ligament, and the carpal tunnel syndrome quickly became painful.

3 cortisone test. Hydrocortisone is injected into the carpal tunnel, and pain relief can help confirm the diagnosis.

4 tourniquet test. Inflating the sphygmomanometer to 30 to 60 seconds above the systolic blood pressure can induce positive finger pain.

5 extended wrist test. Maintaining the wrist in the overstretched position, the person who is soon suffering from the pain is positive.

6 finger pressure test. In the proximal rim of the transverse ligament of the wrist, the median nerve compression point is positive with finger pressure and can induce finger pain.

7 median nerve conduction velocity. Normally, the median nerve has a motor fiber conduction velocity of less than 5 microseconds from the proximal wrist transverse to the thumb to the palm muscle or the thumb abductor muscle. If it is longer than 5 microseconds, it is abnormal. Carpal tunnel syndrome can be up to 20 microseconds, indicating damage to the median nerve. Surgical treatment should be considered for conduction times greater than 8 microseconds.

Differential diagnosis

Many diseases can have symptoms similar to those of carpal tunnel syndrome, such as finger numbness, pain, and the like. Therefore, attention should be paid to identification to prevent misdiagnosis.

(1) The most important difference in differential diagnosis is the differentiation between peripheral neuritis and radiculopathy.

Peripheral neuritis is mainly numbness of the fingers, and the pain is mild. Most of them are hands, showing a symmetry-sensing disorder, and it is not difficult to identify.

(2) The identification of cervical spondylotic radiculopathy and carpal tunnel syndrome is very important. Both can have numbness and pain in the fingers, but the treatment is completely different. At the same time, the two may exist at the same time, that is, the same patient suffering from cervical spondylosis and carpal tunnel syndrome at the same time, need to be carefully distinguished, respectively, in order to achieve good results.

Cervical spondylotic radiculopathy is characterized by painful radiation that radiates from the neck and shoulders to the distal end. The patient has symptoms of the neck, shoulders, upper limbs and hands. Pain has a certain relationship with neck activity. Cervical X-ray films and CT can show cervical degeneration, and the corresponding nerve roots are narrow. A wide range of pain and sensory disturbances. Electromyography can provide a basis for differential diagnosis. Carpal tunnel syndrome is characterized by nocturnal finger pain, positive pressure finger test, and electromyography examination of the median nerve conduction velocity from the proximal wrist transverse stripes to the large fish.

(3) In addition, it must be differentiated from peripheral neuritis, diabetic peripheral neuritis, rheumatoid arthritis and rheumatoid arthritis, hypothyroidism, gout, and the like.

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